Department of Cardiology, Kurashiki Central Hospital.
Circ J. 2017 Dec 25;82(1):211-217. doi: 10.1253/circj.CJ-17-0477. Epub 2017 Aug 31.
Stent fracture (SF) and peri-stent contrast staining (PSS) after sirolimus-eluting stent (SES) implantation are considered to be related to very late stent thrombosis (VLST). How dual antiplatelet therapy (DAPT) beyond 1 year affects the clinical outcomes of patients with SF or PSS remains unclear.Methods and Results:Based on their DAPT status, 1,962 patients undergoing SES implantation were classified as on-thienopyridine (n=1,404) or off-thienopyridine (n=558). The 6-year incidence of VLST was significantly lower in the on-thienopyridine patients (0.56% vs. 1.8%, P=0.01), whereas cardiac death and myocardial infarction (MI) were similar (5.0% vs. 6.2%, P=0.31; 3.2% vs. 4.0%, P=0.33; respectively). The 1,962 patients were also classified as having SF/PSS (n=256) or non-SF/PSS (n=1,706). In the SF/PSS group, VLST and MI were significantly lower in on-thienopyridine patients (1.9% vs. 10.1%, P=0.003; 3.5% vs. 10.3%, P=0.02; respectively). In the non-SF/PSS group, VLST and MI were similar (0.36% vs. 0.45%, P=0.78; 3.2% vs. 3.0%, P=0.93; respectively). In both groups, cardiac death was similar (3.6% vs. 4.3%, P=0.78; 5.2% vs. 6.5%, P=0.32; respectively).
Prolonged DAPT was associated with significantly lower incidences of VLST and MI in the SF/PSS group, but had no effect on cardiac death, VLST, or MI in the non-SF/PSS group.
西罗莫司洗脱支架（SES）植入后支架断裂（SF）和支架内对比染色（PSS）被认为与极晚期支架血栓形成（VLST）有关。在 SF 或 PSS 患者中，DAPT 超过 1 年对临床结局的影响尚不清楚。
根据 DAPT 状态，将 1962 例接受 SES 植入的患者分为噻吩吡啶类药物（n=1404）或噻吩吡啶类药物（n=558）。噻吩吡啶类药物组的 6 年 VLST 发生率显著低于噻吩吡啶类药物组（0.56% vs. 1.8%，P=0.01），而心脏死亡和心肌梗死（MI）相似（5.0% vs. 6.2%，P=0.31；3.2% vs. 4.0%，P=0.33）。1962 例患者还分为 SF/PSS（n=256）或非 SF/PSS（n=1706）。在 SF/PSS 组中，噻吩吡啶类药物组的 VLST 和 MI 显著降低（1.9% vs. 10.1%，P=0.003；3.5% vs. 10.3%，P=0.02）。在非 SF/PSS 组中，VLST 和 MI 相似（0.36% vs. 0.45%，P=0.78；3.2% vs. 3.0%，P=0.93）。两组的心脏死亡相似（3.6% vs. 4.3%，P=0.78；5.2% vs. 6.5%，P=0.32）。
延长 DAPT 与 SF/PSS 组 VLST 和 MI 的发生率显著降低相关，但对非 SF/PSS 组的心脏死亡、VLST 或 MI 无影响。
